What’s the Diagnosis – Case 169
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Findings The radiographs (particularly in retrospect) demonstrate stranding of the fat in keeping with edema of the subcutaneous fat subsequently seen on the MRI images. The MRI demonstrates prominent edema (as shown by high signal on the PD and IR pulse sequences) of multiple muscle groups inclusive of the deltoid, triceps, biceps, and extending into the flexor and extensor musculature of the forearm.
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Diagnosis: Rhabdomyolysis Rhabdomyolysis is the breakdown of striated muscle which can be seen related to trauma, prolonged immobilization, or as in this case overuse. The breakdown products of muscle can lead to cardiac, hepatic, and especially renal complications. The imaging findings of rhabdomyolysis have some overlap with delayed onset muscle soreness or DOMS. Both will have edema in muscle or muscle groups and may have edema of the subcutaneous soft tissue. The findings of DOMS are not as pronounced but overlap is certainly present. Often the clinical scenario helps distinguish the degree of pathology with rhabdomyolysis presenting rapidly as compared to a 24-48 hour delay in DOMS and with the pain of rhabdomyolysis persisting at rest while the pain of DOMS frequently mitigated by rest. The patient in this situation was treated with aggressive IV hydration and rest and thankfully had no other complications.
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References Imaging Findings in the Setting of Rhabdomyolysis. Emily Neal, Steve Burky, MD. Applied Radiology Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Mónica Ballesta Moratalla, Petra Braun, Guillermina Montoliu Fornas. Eur J Radiol. 2008 Feb;65(2):311-5. doi: 10.1016/j.ejrad.2007.03.033. Epub 2007 May 4.
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